We are happy to announce that we have received another accolade. We have been recognized as a top provider of Morpheus8 in Canada and North America. Morpheus8 is an extremely popular treatment for the creation of new collagen and elastin in the skin. We are grateful to be recognized for our treatment regimens and success with this modality by Inmode.
We are happy to announce that Nakatsui DermaSurgery has again received the Top Choice Award for Best Cosmetic Clinic in 2024. While it’s almost impossible to receive this every year, we are thankful this is the fourth time in recent years that we have received this honour. Our dermatologist, Dr. Nakatsui, wants to thank everyone for voting us the Best Cosmetic Clinic again in 2024! We know there are a lot of clinics out there and it’s always nice to know that others think we’re worth nominating for our excellence in our cosmetic treatments.
Currently, there is a biologic agent called dupixent for atopic dermatitis. This is a fairly effective medication that inhibits IL-13 but there is a new IL-13 inhibitor called tralokinumab that is currently being investigated. A study published in the Annals of Allergy, Asthma & Immunology in December of 2020 demonstrated improved quality of life in patients with moderate to severe atopic dermatitis. It shows good promise and may be available later this year or in 2022.
Qwo is an exciting new approach to cellulite treatment using collagenase. Over the years, there have been many devices and treatments that have tried to treat cellulite. Many of these treatments have not been very effective. Cellulite refers to a dimpled appearance of the skin that is present in 80-98% of adult women. This dimpled appearance is due in part to fibrous septae in the dermal subcutaneous tissue. These fibrous septae are made of collagen. Other conditions such as Dupuytren’s and Peyronie’s disease have shown good benefit from collagenase treatments.
A new agent called Qwo has been approved in the USA for the treatment of cellulite. It is composed of two types of collagenase that hydrolyze Type I or III collagen. The collagenase is referred to as collagenase clostridium histolyticum and is produced by Endo Aesthetics. Two double blind, placebo controlled phase 3 studies showed significant improvement from 3 treatments of Qwo with each being 21 days apart. The results appear compelling even with patients with severe cellulite and Dr. Nakatsui is looking forward to this product being released in Canada as up till now, there have not been any really effective treatments.
Reference:
Collagenase Clostridium Histolyticum-aaes for the Treatment of Cellulite in Women: Results From Two Phase 3 Randomized, Placebo-Controlled Trials.Kaufman-Janette J, Joseph JH, Kaminer MS, Clark J, Fabi SG, Gold MH, Goldman MP, Katz BE, Peddy K, Schlessinger J, Young VL, Davis M, Hurley D, Liu G, McLane MP, Vijayan S, Bass LS.Dermatol Surg. 2021 May 1;47(5):649-656.
The Nakatsui DermaSurgery Centre is a Chartered Surgical Facility and is committed to keeping you and our staff safe. We have made the decision to continue following our health protocols currently in place. Masks will still be required in our common areas when visiting our clinic, and we will continue to conduct health screening at the door. We will reassess our processes and will update you at that time. We thank you for helping keep our NDS community and staff safe.
In December or 2020, there were a few reports of patients developing transient facial and lip swelling in patients who have received a dose of the Moderna vaccine. All of these patients had previously received hyaluronic acid (HA) fillers. These reactions all resolved quickly and similar reactions have been reported with other COVID-19 vaccines and with other types of vaccinations as well.
In March of 2021, the Canadian Dermatology Association (CDA) issued recommendations regarding COVID-19 vaccinations and hyaluronic acid (HA) dermal filler use.
They recommended:
Tapinarof is an investigational drug that is being studied for the treatment of psoriasis and atopic dermatitis. It is a topical aryl hydrocarbon receptor (AhR)-modulating agent. Tapinarof binds and activates AhR, which leads to downregulation of inflammatory cytokines such as interlukin 17.
Phase 2 clinical studies with a topical cream showed improvement in psoriasis after two weeks of cream with maintenance of improvement for 4 weeks after treatment discontinuation.
This prompted a phase 3 clinical trial for psoriasis using tapinarof 1% cream applied once daily. We are now awaiting the results of the randomized controlled trials.
A phase 2b study published in the Journal of the American Academy of Dermatology on the effectiveness of tapinarof on atopic dermatitis showed good improvement following use of topical 1% cream.
Reference:
Efficacy and patient-reported outcomes from a phase 2b, randomized clinical trial of tapinarof cream for the treatment of adolescents and adults with atopic dermatitis. Paller AS, Stein Gold L, Soung J, Tallman AM, Rubenstein DS, Gooderham M.J Am Acad Dermatol. 2021 Mar;84(3):632-638. doi: 10.1016/j.jaad.2020.05.135. Epub 2020 Jun 2.
A hyaluron pen is a device that inserts hyaluronic acid filler into the skin using pressure. They are being sold and used by several manufactures, spas, and estheticians. These are also known as hyapens, fog injection devices, SERA pens. and nebulizer injector guns.
These pens are medical devices first designed to help administer insulin and use pressure technology to insert agents into the skin. They are heavily marketed as needle-free and painless. Consumers are being told that the pens can help create volume for lips, nasolabial folds, marionette lines, frown lines, and forehead wrinkles.
The Hyaluron Pen is not entirely safe. As with any device, it carries potential risks. Potential side effects of the Hyaluron Pen include:
Consumers are being told there is no risk of vascular (blood vessel) occlusion but the hyaluron pen can occasionally cause damage to the blood vessels. If this should occur at home or in a spa, who is going to manage this? Does the aesthetician know what to do to minimize the magnitude of the injury? Does the aesthetician have the correct medication available in the spa to quickly address the issue?
In September of 2019, Health Canada issued a recall and safety alert regarding Hyaluron pens and does not authorize the sale of any needle-free dermal filler devices in Canada. Heath Canada states it is illegal to advertise, import, or sell these devices. Despite this, many spas continue to offer it. If you are aware of a violation, you can report it here.
In February of 2021, the American Society for Dermatologic Surgery Association has issued a Patient Safety Alert regarding the Hyaluron Pen and its dangers to kids. Members have observed social media postings with videos of kids self-administering these pens. This is potentially very dangerous and if you have a hyaluron pen in the home, please keep it away from your kids.
The simplest way to understand what is meant by being Board Certified is this: when a physician passes his or her qualifying examinations to become a dermatologist, the certifying body grants the physician the right to say he or she is a bona fide certified dermatologist and is Board certified.
For dermatologists, being Board certified is most appropriate when referring to the situation where the American Board of Dermatology grants their approval and the dermatologist can add to their credentials the designation DABD (Diplomate of the American Board of Dermatology). Hence, the dermatologist is Board Certified.
In Canada, the equivalent certifying body is the Royal College of Physicians and Surgeons. When a dermatologist becomes certified in Canada, he can use the designation FRCPC (Fellow of the Royal College of Physicians of Canada). As you can see, there is no actual board in Canada but we commonly use this term as it widely understood.
Dr. Nakatsui’s designation is Thomas Nakatsui, MD FRCPC FAAD DABD. What does all of that mean? Well, MD refers to his medical degree, FRCPC refers to his Canadian qualifications, and DABD refers to his American Board certification. So what is FAAD?
FAAD means Fellow of the American Academy of Dermatology. The AAD does not grant certification but you can only join once you have received your DABD or FRCPC. The difference with FAAD is that there is no requirement for maintenance of competency so once you have it, you don’t lose it. FRCPC and DABD designations can be lost and require maintenance of competency to maintain. For the DABD, this usually means rewriting an exam every 10 years. So you can have your FAAD but no longer be board certified. If you want to check if your dermatologist is still board certified, you can check here.
So what does it mean when someone says they are double board certified? Being certified in both Canada and the USA is not precisely the same as being double board certified. Usually when doctors speak of being double board certified, it means they have embarked on training in two different areas of medicine that are governed by different boards. For example, one of our dermatologists, Dr. Schloss, has received certification in both Pathology and Dermatology and thus is double board certified. If he was certified in both of these areas in both Canada and the USA, he would not claim he was quadruple board certified.
Hopefully, this explains what it means to be board certified (and double board certified), and explains what all those designations mean.
A common question we get is whether or not patients on systemic therapies for skin conditions such as psoriasis, eczema, or lupus can receive any of the COVID-19 vaccines. These patients are usually concerned about the possibility that they will be susceptible to developing side effects or infection as a result of the immunosuppressive properties of many of their systemic medications (e.g. biologic medications).
Our advice has been for all of our patients to get vaccinated when they can as long as they do not have a known allergy to any portion of the vaccine. The COVID-19 Pfizer and Moderna vaccines are mRNA vaccines and thus do not contain any live virus. As a result, receiving these vaccines should not pose any increased risk.
Another question we get is whether or not they should discontinue or hold their medication doses around the time of their vaccination to prevent the medication from decreasing their body’s ability to respond to the vaccine. At this point, we believe they should continue their medications when they receive their vaccinations.
The Canadian Dermatology Association recently published a position statement on this and declared:
1. All patients, regardless of ongoing treatment, should receive [COVID-19] vaccination unless they have documented, severe reactions to one or more vaccine constituents.
2. Modest attenuation of vaccine effectiveness is expected with some drugs [but] only when maximization of vaccine effectiveness is of paramount concern should interruption of systemic therapy be considered.
Psoriasis is driven by elevated levels of cytokines in the skin and joints, stimulating inflammation. These cytokines also circulate in the blood, stimulating inflammation elsewhere in the body.
One study recently looked at the effect of systemic treatments for psoriasis on mortality in patients with moderate to severe psoriasis. The study was comprised of 12,099 adult patients with moderate to severe psoriasis who were followed followed for up to 10 years.
The study found that treatment with biologics and methotrexate was associated with lower risks of mortality. Systemic therapy appears to not only help with the skin and joints, but also may help reduce inflammation systemically.
Reduced risk of mortality associated with systemic psoriasis treatment in the Psoriasis Longitudinal Assessment and Registry (PSOLAR): A nested case-control analysis. Langley RG, Poulin Y, Srivastava B, Lafferty KP, Fakharzadeh S, Langholff W, Augustin M. J Am Acad Dermatol. 2021 Jan;84(1):60-69.
Bullous pemphigoid is an autoimmune disorder characterized by the development of tense blisters on various areas of the body. Dupilumab (Dupixent) is a monoclonal antibody used initially in the management of atopic dermatitis, a type of eczema. Dupixent works on IL-4 and IL-31 receptors, effectively blocking them and this is how it helps control atopic dermatitis.
A recent multicenter trial demonstrated that 92.3% of patients treated with Dupixent achieved complete clearance or satisfactory response with no adverse effects. Typically, we have used either oral steroids or oral methotrexate, which are potent immunosuppressants, to control moderate to severe cases of bullous pemphigoid.
Dupixent may be a useful additional tool for the management of bullous pemphigoid.
Dupilumab as a novel therapy for bullous pemphigoid: A multicenter case series. Abdat R, Waldman RA, de Bedout V, Czernik A, Mcleod M, King B, Gordon S, Ahmed R, Nichols A, Rothe M, Rosmarin D. J Am Acad Dermatol. 2020 Jul;83(1):46-52.
Chronic nodular prurigo is a very difficult problem to treat. It is characterized by severely itchy papules and nodules scattered over the extremities and buttocks. It is a multi-factorial skin disease that is often refractory to treatment. Treatments include topical steroids, topical calcineurin inhibitors, phototherapy, antidepressants, and other medications.
A recent article in the Journal of the American Academy of Dermatology described a cohort of patients who were placed on dupilumab ( a monoclonal antibody that inhibits IL-4 and IL-13 and otherwise known as Dupixent) who responded extremely well after 16 weeks of therapy. IL-4 and IL-13 may help stimulate the itch-sensory neuronal pathways; consequently, inhibiting this pathway would be theoretically helpful. Further studies are required to substantiate this finding but this gives patients with this condition some hope that there is an effective treatment.
Dupilumab improves clinical manifestations, symptoms, and quality of life in adult patients with chronic nodular prurigo. Chiricozzi A, Maurelli M, Gori N, Argenziano G, De Simone C, Calabrese G, Girolomoni G, Peris K. J Am Acad Dermatol. 2020 Jul;83(1):39-45.
At Nakatsui DermaSurgery, sebaceous hyperplasia are most commonly treated with the CO2 resurfacing laser. A recent study on a new treatment modality was published in Dermatologic Surgery on the use of nanosecond pulsed electric field therapy. Each sebaceous hyperplasia lesion was treated 1-2 times. Ninety percent of lesions cleared with electric field therapy. With respect to pain, 54% reported mild pain, whereas 15% reported moderate pain with treatment Patients did experience hyperpigmentation although this gradually faded with time. At day 60, 45% of lesions were hyperpigmented. Redness and swelling were noted initially but did nor persist. One of the persistent side effects was that of small depressions at 19% of treatment sites.
This is an interesting new technique for treatment of sebaceous hyperplasia. Whether it will replace the use of CO2 resurfacing remains to be seen. Find out more about sebaceous hyperplasia.
Safety and Efficacy of Nanosecond Pulsed Electric Field Treatment of Sebaceous Gland Hyperplasia. Munavalli GS, Zelickson BD, Selim MM, Kilmer SL, Rohrer TE, Newman J, Jauregui L, Knape WA, Ebbers E, Uecker D, Nuccitelli R. Dermatol Surg. 2020 Jun;46(6):803-809.
Hidradenitis suppurativa is a chronic, inflammatory, acne-like condition affecting the skin folds. It is a difficult condition to treat, and treatments range from oral and topical antibiotics to injectable biologic medications like Humira (adalimumab).
One of the common antibiotic regimens is a combination of clindamycin and rifampin. A recent study in the Journal of the American Academy of Dermatology suggests that clindamycin alone may be just as effective as clindamycin and rifampin.
In this study, 60 patients were treated with either clindamycin alone or with a combination of clindamycin and rifampin. At the end of 8 weeks of therapy, the benefits were found to be similar in both groups.
Although more studies need to be done, this study suggests we may be able to treat this condition with a single antibiotic rather than a combination.
Botox is used very commonly to decrease the size of the masseters and to improve symptoms such as grinding, headaches, and TMJ disorders. Decreasing the size of the masseters leads to a slimming of the lower face. This type of non-surgical lower face contouring is very popular, particularly among Asians.
A recent review published in Dermatologic Surgery went through different injection methods for botulinum injections of the masseters in East Asians. Five different methods for injecting the masseters were described.
Different patients have different patterns of masseter hypertrophy and Dr. Nakatsui can decide which is the best way to inject you. Care must be taken when injecting as some of the side effects of injection include a sunken appearance to the cheek, focal bulging of the masseter, and weakening of the risorius muscle, which would affect your smile.
There are many hair changes attributable to anticancer therapies. In approximately 65% of patients treated with chemotherapy and in up to 100% of areas treated with radiotherapy can lead to hair changes.
These can manifest as hair loss (alopecia), pigment changes, textural changes, and changes in hair cycle.
Chemotherapy induced hair loss typically begins weeks after the first dose of chemotherapy and represents what is called an anagen effluvium, predominantly in areas of increased friction on the scalp. Eyebrows and eyelashes may also be affected. Usually asymptomatic, it can be associated with itch or pain. Two to six months after the chemotherapy has finished, the hair typically begins to regrow, although the hair loss can be persistent.
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For this holiday season, our clinic will be closed from December 24, 2020 to December 31, 2021, although we will continue to answer phones to book appointments during regular office hours.
The office will be completely closed from January 1 to January 3, 2021, and we will not be answering phones on those days. We will also be closed all statutory holidays and including Easter Monday. Thank you and have a great holiday season! See you in 2021!
We have used oral minocycline for rosacea for decades. However, there are risks associated with oral minocycline, even though they are rare. A topical formulation of minocycline is being investigated for the management of rosacea by a company called Vyne Therapeutics. Two studies with a total of 1521 patients compared 1.5% topical minocycline foam versus vehicle and the foam appears to be effective, safe, and well-tolerated. This may provide a good alternative for rosacea sufferers looking to avoid oral medications.
A phase 2b study by Asana Biosciences regarding a novel new medication for moderate to severe chronic hand eczema has shown some encouraging results. The medication is called gusacitinib and is a dual JAK/SYK inhibitor. The study showed statistically significant improvements in chronic hand eczema severity compared to placebo. It had an acceptable safety profile and was well tolerated. The most common side effects were headache, nausea, nasopharyngitis, and upper respiratory tract infection. A phase 3 trial is being finalized.